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South Dakota rates for HCPCS 21263

Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,231.36 / $2,231.36 / $2,231.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.42 / $2,231.36 / $5,297.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,853.74 / $5,016.62 / $6,270.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,670.21 / $3,493.71 / $5,072.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,072.83 / $4,048.34 / $24,626.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,993.32 / $5,080.68 / $6,946.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,993.32 / $4,258.78 / $6,026.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,318.62 / $3,562.24 / $4,371.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,116.91 / $3,848.92 / $6,297.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,336.89 / $5,306.40 / $5,306.40